Implementation and impact on length of stay of a post-discharge remote patient monitoring program for acutely hospitalized COVID-19 pneumonia patients

ObjectiveIn order to manage COVID-19 patient population and bed capacity issues, remote patient monitoring (RPM) is a strategy used to transition patients from inpatients to home. We describe our RPM implementation process for post-acute care COVID-19 pneumonia patients. We also evaluate the impact of RPM on patient outcomes, including hospital length of stay (LOS), post-discharge Emergency Department (ED) visits, and hospital readmission.Materials and methodsWe utilized a cloud-based RPM platform (Vivify Health) and a nurse-monitoring service (Global Medical Response) to enroll COVID-19 patients who required oxygen supplementation after hospital discharge. We evaluated patient participation, biometric alerts, and provider communication. We also assessed the program's impact by comparing RPM patient outcomes with a retrospective cohort of Control patients who similarly required oxygen supplementation after discharge but were not referred to the RPM program. Statistical analyses were performed to evaluate the 2 groups' demographic characteristics, hospital LOS, and readmission rates.ResultsThe RPM program enrolled 75 patients with respondents of a post-participation survey reporting high satisfaction with the program. Compared to the Control group (n = 150), which had similar demographics and baseline characteristics, the RPM group was associated with shorter hospital LOS (median 4.8 vs 6.1 days; P=.03) without adversely impacting return to the ED or readmission.ConclusionWe implemented a RPM program for post-acute discharged COVID-19 patients requiring oxygen supplementation. Our RPM program resulted in a shorter hospital LOS without adversely impacting quality outcomes for readmission rates and improved healthcare utilization by reducing the average LOS

Electronic health record solutions to reduce central line-associated bloodstream infections by enhancing documentation of central line insertion practices, line days, and daily line necessity.

BackgroundCentral line-associated bloodstream infections (CLABSIs) continue to cause preventable morbidity and mortality, but methods for tracking and ensuring consistency of CLABSI-prevention activities remain underdeveloped.MethodsWe created an integrated electronic health record solution to prompt sterile central venous catheter (CVC) insertion, CVC tracking, and timely line removal. The system embedded central line insertion practices (CLIP) elements in inserter procedure notes, captured line days and new lines, matching each with its CLIP form and feeding back compliance, and enforced daily documentation of line necessity in physician progress notes. We examined changes in CLIP compliance and form submission, number of new line insertions captured, and necessary documentation.ResultsStandard reporting of CLIP compliance, which measures compliance per CLIP form received, artificially inflated CLIP compliance relative to compliance measured using CVC placements as the denominator; for example, 99% per CLIP form versus 55% per CVC placement. This system established a higher threshold for CLIP compliance using this denominator. Identification of CVCs increased 35%, resulting in a decrease in CLABSI rates. The system also facilitated full compliance with daily documentation of line necessity.ConclusionsIntegrated electronic health records systems can help realize the full benefit of CLABSI prevention strategies by promoting, tracking, and raising the standard for best practices behavior

Electronic health record solutions to reduce central line-associated bloodstream infections by enhancing documentation of central line insertion practices, line days, and daily line necessity

BackgroundCentral line-associated bloodstream infections (CLABSIs) continue to cause preventable morbidity and mortality, but methods for tracking and ensuring consistency of CLABSI-prevention activities remain underdeveloped.MethodsWe created an integrated electronic health record solution to prompt sterile central venous catheter (CVC) insertion, CVC tracking, and timely line removal. The system embedded central line insertion practices (CLIP) elements in inserter procedure notes, captured line days and new lines, matching each with its CLIP form and feeding back compliance, and enforced daily documentation of line necessity in physician progress notes. We examined changes in CLIP compliance and form submission, number of new line insertions captured, and necessary documentation.ResultsStandard reporting of CLIP compliance, which measures compliance per CLIP form received, artificially inflated CLIP compliance relative to compliance measured using CVC placements as the denominator; for example, 99% per CLIP form versus 55% per CVC placement. This system established a higher threshold for CLIP compliance using this denominator. Identification of CVCs increased 35%, resulting in a decrease in CLABSI rates. The system also facilitated full compliance with daily documentation of line necessity.ConclusionsIntegrated electronic health records systems can help realize the full benefit of CLABSI prevention strategies by promoting, tracking, and raising the standard for best practices behavior

Plexus 2018: Synergy

PLEXUS is a student-organized publication that showcases artwork by medical students, physicians, faculty, patients, and others in the medical community. True to its name, PLEXUS aspires to connect those who seek to heal and to be healed through the unifying language of art. This year we continued to expand our presence in the UCI medical community and beyond.For our 19th edition of PLEXUS, we chose the theme of “Synergy” - a theme that implies collaboration, teamwork, and a merging of perspectives. In the interdisciplinary field of medicine, patients and their team of healthcare providers come to the table with unique beliefs, experiences, and insights that inform their decisions and attitudes. While the journal submission and publication process is run by medical students, we believe that the medical humanities is a creative space  open to everyone in the medical community. This year we included wonderful submissions from students in the UCI School of Nursing, as well as graduate students from the biological sciences. It is in seeing and hearing from others’ perspectives that we broaden our horizons and improve ourselves.Every year we are amazed by the emotions, reflections, stories, richness, and creativity of the submissions. We thank all of our submitters for their time and thought. Additionally, please find our performing arts pieces on our website, www.uciplexus.org. Previous publications and submissions are also available online.Winners of the PLEXUS medical student competitions were made possible by the Program in Medical Humanities & Arts.Congratulations to this year’s winners:Writing competition: 1st: Melinda Schneider, MS2 “Mouse Brains and Microtomes”; 2nd: Leigh Goodrich, MS4 “One Million and One”; 3rd: Nazin Sedehi, MS2 “To my class with Love”Visual competition: 1st: Soe Thein, MS3 “Nurture”; 2nd: Kimberly Watanabe, MS3 “Black Diamond Healer”; 3rd: Stephanie Noh, MS2 “Field of Psammoma Bodies”Performing arts competition: 1st: Jovauna Currey, Resident “The Synergy of the Patient/Physician Relationship”; 2nd: Alex Miner, Resident “Squeeze”; 3rd: Nathan Calixto & Chris Gabriel, MS3s “Tears in Heaven” by Eric Clapton.Thank you to our superb editors, staff, and faculty for their support in making this 19th edition possible. We would like to give special thanks to our faculty advisor, Dr. Johanna Shapiro and Dr. Ellena Peterson, Associate Dean of Admissions & Outreach - this book would not have been possible without your continuous support and guidance. We hope you enjoy PLEXUS 2018 – Synergy. Plexus Editors-In-Chief: Celia Cheung, Joanna TurkiewiczProject HX - Editor-In-Chief: Thalia NguyenCreative Writing & Visual Arts Team: Yvonne Lu, Julie Ferris, Shreya Aiyar, Arnie Shah, Julia Tran, Sarah O’Dell, Priyanka Sharma, Ava RungeDesign Team: Priyanka Sharma, Christina Kong, Nazin SedehiDigital And Social Media Editor: Christine PhamPerforming Arts Chair: Melinda SchneiderTo contribute to PLEXUS or to request a PLEXUS exhibit at your event, please visit www.uciplexus.orgFollow us at www.facebook.com/uciplexus Contest winners1st place winner:  Melinda Schneider2nd place winner: Leigh Goodrich3rd place winner: Nazin Sedeh

Reductions in Clostridium difficile Infection (CDI) Rates Using Real-Time Automated Clinical Criteria Verification to Enforce Appropriate Testing.

C. difficile PCR testing identifies both colonized and infected patients, making it critical to only test patients that meet clinical criteria for C. difficile infection (CDI). We implemented an automated order-entry protocol that reduced inappropriate testing by 64% and hospital-onset (HO) CDI Standardized Infection Ratio (SIR) from 1.62 to 0.82

Plexus 2012

PLEXUS would like to give a special thanks to our faculty advisor, Dr. Johanna Shapiro. This publication would not have been possible without the support of the UC Irvine School of Medicine and Dr. Ellena Peterson.This edition of PLEXUS is dedicated to THOMAS SAGE HAND (March 27, 1985 — January 15, 2012)Sponsors: UCI School of Medicine Dean’s Office, Office of Educational Affairs, and Office of AdmissionsPast Plexus Editors: David Cheng, Stephanie Le, Virginia Liu, Nupoor NarulaEditors in Chief: Nina Narasimhalu, Nguyen NguyenCreative Writing: Lorianne Burns, Samantha Costantini, David TranVisual Arts:  Christine Lee, Kimberly TruongLayout & Design: Christine Lee, Hanna LiuAudio: Melody Besharati, Andrew TreisterMarketing & Outreach: Christopher NguyenAudio Available Online http://www.meded.uci.edu/Medhum/plexus.asp Published works were contributed by UCI School of Medicine students, physicians, faculty, staff, alumni and patients.Thank you to Printing Division, Inc. © 2012 Plexus

Reductions in Clostridium difficile Infection (CDI) Rates Using Real-Time Automated Clinical Criteria Verification to Enforce Appropriate Testing.

C. difficile PCR testing identifies both colonized and infected patients, making it critical to only test patients that meet clinical criteria for C. difficile infection (CDI). We implemented an automated order-entry protocol that reduced inappropriate testing by 64% and hospital-onset (HO) CDI Standardized Infection Ratio (SIR) from 1.62 to 0.82

Plexus 2014: Equilibrium & Transformation

Plexus is a student-organized publication that showcases artwork by UCI School of Medicine students, physicians, faculty, staff and patients. True to its name, PLEXUS aspires to connect those who seek to heal and to be healed through the unifying language of art.This year, the Plexus team is excited to introduce some ‘firsts’ - a theme, the traveling Plexus exhibit, a separate Art for the Soul section and inclusion of performance arts. You were invited to embody the theme of ‘Equilibrium & Transformation’ in your art and what a response! Thank you for sharing your wealth of emotion and perspective. Due to an overwhelming number of requests to display Plexus at events last year, we have produced our own moveable feast of 5-10 of our most prominent pieces from Plexus 2013 and displayed it during Solidarity Day 2014 and at Irvine Hall, and plan to display an updated version at UCI Medical Center during various departmental events this year. We have also highlighted work created by cancer survivors through the Art for the Soul program in a separate section and have added a ‘Performance’ section on the Plexus website to respond to the community’s passion for dance and drama.Congratulations to this year’s winners of the medical student writing competition! 1st: Anjali Hari, MS2 ‘Maya’ 2nd: Jiwon Shin, MS1 ‘The Remnants’ and 3rd: Lorianne Burns, MS3 ‘Conversation Unspoken’.Thank you to our wonderful Editors who helped bring all the changes to fruition, and for bringing thoughtful criticism and inspiration to our creative vision. We would like to thank Dean Clayman for sponsoring the traveling Plexus exhibit. We would like to give special thanks to our faculty advisor, Dr. Johanna Shapiro and Dr. Ellen Peterson, Associate Dean of Admissions and Outreach. This book would not have been possible without your support.We hope you enjoy PLEXUS 2014. Bon voyage!Editors-In-Chief: Nabila Haque, Esther JunDigital Editor-In-Chief: Adam TruongCreative Writing: Jacqueline Kurth, Christy TabitLayout, Design & Visuals: Ben Nguyen, Kevin GustafsonAudio & Performance: Jessica Galant, Evelyn Hoover, Katherine SternMarketing And Outreach: Avinash Chaurasia, Jiwon Helen ShinWebsite Design: Neil Saez1st Place Winner of PLEXUS Student Writing Competition made possible by UCISOM Humanities Dept.: Anjali Hari2nd Place Winner; Jiwon Helen Shin3rd Place Winner: Lorianne BurnsTo contribute to Plexus or to request the Plexus exhibit at your event, please send email [email protected]. We look forward to hearing from you